淋巴细胞亚群失衡与EV71型手足口病重症化的相关性

Correlation between the unbalanced lymphocyte subsets and the aggravation condition of hand, foot and mouth disease with EV71 infection

目的研究EV71型手足口病患儿淋巴细胞亚群失衡与手足口病重症化之间的相关性。方法收集2013年4月至2015年10月间本院收治的EV71型手足口病患儿共496例,根据病情分为普通型组(220例)、重症组(191例)以及危重症组(85例);选择同期本院门诊100例健康体检儿童为对照组。采取流式细胞仪检测各组患儿外周血T淋巴细胞(CD3^+)、Th细胞(CD3^+CD4^+)、Tc细胞(CD3^+CD8^+)、NK细胞(CD16^+56^+)和B淋巴细胞(CD19^+)数量及其所占淋巴细胞的百分比,并应用ELISA法测定各组细胞因子IL-6、IL-10、TNF-α和IFN-γ的血清浓度。结果淋巴细胞亚群CD3^+、CD3^+CD4^+、CD3^+CD8^+的百分比在对照组、普通型组、重症组和危重症组中逐渐降低;而CD19^+则呈相反趋势;CD16^+CD56^+百分比在对照组、重症组、普通型组、危重症组中依次降低。各组淋巴细胞亚群差异具有统计学意义(F=243.38、206.52、41.85、4.27、314.54,P均<0.05),而组间比较中,除重症组和危重症组患儿CD3^+CD4^+、对照组和重症组以及普通型组和危重症组患儿CD16^+CD56^+差异无统计学意义外(P>0.05),其余各组差异具有统计学意义(P均<0.05)。细胞因子IL-6和IL-10在对照组、普通型组、重症组和危重症组中逐渐升高;TNF-α和IFN-γ在对照组、普通型组、重症组中逐渐升高,但在危重症组中却出现下降。各组细胞因子差异具有统计学意义(F=55.32、75.47、416.37、321.31,P均<0.05);而组间多重比较中,差异亦具有统计学意义(P均<0.05)。结论 EV71型手足口病患儿存在细胞免疫功能紊乱和炎症因子失调;淋巴细胞亚群失衡可能为手足口病重症化的重要因素之一。

Objective To investigate the correlation between the unbalanced lymphocyte subsets and the aggravation condition of children with EV71-assoicated hand, foot and mouth disease （HFMD）. Methods Total of 496 patients with EV71-assoicated HFMD were collected in the hospital from April 2013 to October 2015, and were divided into the common group （220 cases）, severe group （191 cases） and critical group （85 cases）. While 100 healthy children who received checkup during the same period were recruited in the control group. The lymphocyte subsets in peripheral blood, including T lymphocytes （CD3＋）, Th cells （CD3＋CD4＋）, Tc cells （CD3＋CD8＋）, NK cells （CD16＋56＋） and B lymphocytes （CD19＋） were detected by fowcytometry in terms of count and percentage in total lymphocytes. And the serum levels of IL-6, IL-10, TNF-α and IFN-γ were determined by ELISA. Results The percentages of such lymphocyte subsets as CD3＋, CD3＋CD4＋ andCD3＋CD8＋ were decreased sequentially in the control group, and the common, severe and critical groups; and the oppositely sequential decline was indicated in the percentage of CD19＋. The percentage of CD16＋CD56＋ was reduced sequentially in the control group, and the severe, common and critical groups. The lymphocyte subsets were signifcantly different among the patients in different groups （F = 243.38, 206.52, 41.85, 4.27, 314.54; all P 〈 0.05）. In inter-group comparison, no signifcant difference of CD3＋CD4＋ was observed between the severe and critical groups （all P 〉 0.05）, and no signifcant difference of CD16＋CD56＋ were observed between the control group and the severe group and also between the common and critical groups （all P 〉 0.05）; a signifcant difference of the other subsets was indicated among the four groups （all P 〈 0.05）. The levels of such cytokines as IL-6 and IL-10 were increased sequentially in the control group, and the common, severe and critical groups; the levels of TNF-α and IFN-γ were increased sequentially in the control group, the common and severe groups, but decreased in the critical group. The levels of the cytokines were signifcantly different among the four groups （F = 55.32,75.47, 416.37, 321.31; all P 〈 0.05）, a signifcant difference was also observed in multiple inter-group comparisons （all P 〈 0.05）. Conclusions The children with EV71-assoicated HFMD had disordered cellular immune function and abnormal infammatory factors. And the unbalanced lymphocyte subsets may play an important role in the aggravation condition in those with HFMD.